Study on sperm DNA damage

[goldenlove3]

I was searching Google for articles on unexplained IF and came across this article regarding a study from 2012. In this study, 80% of couples with unexplained infertility had "high sperm DNA damage". 

Does anyone know anything about this? Is this something an RE can do a test for or even worth bringing up? Has anyone had this tested?

Article:
www.medscape.com/viewarticle/774842

Study:
www.rbmojournal.com/article/S1472-6483(12)00590-1/abstract

[kensie5226]

The first RE I went to mentioned that they can do a DNA test on his sperm if we wanted. It's experimental and no insurances cover it yet. I was under the implication that it was still pretty controversial, but it was something she mentioned.

[tptbabe]

We had DH tested after our first IVF failed (all embryos arrested on day 5, which is indicative of a sperm issue). We're already dealing with severe MFI, but we planned on ICSI for our first cycle and thought it would bypass our issues. The test itself cost about $450. We're in Canada, and the test was done in-house for us, so it might be more if you have to send it in somewhere. (Only a few places do the test, we're just fortunate to have leading urologists in the field of MFI at our hospital!) DHs came back within parameters, so it doesn't appear that there's an issue there. Our RE told us though, that the frag levels can change frequently, so it wasn't to be taken too seriously. It doesn't really change our treatment plan though, because we're planning on doing PICSI regardless, which is what they're using now to try and bypass frag issues. TESE sperm generally has better frag apparently, because the fragmentation is supposed to happen later on in the maturation process?

[kensie5226]

Oh, yeah our RE said it would be $500 OOP.

[bluejoan]

tptbabe - We did ICSI with our IVF and had 5 poorly graded embryos, transferred the best 2 and the other 3 arrested between day 5 and day 6. We haven't had our WTF yet but did your RE talk to you about adding PICSI or did he leave it up to you? Did they also go over how the embryos did? Our embryology report was pretty slim on information.

[tptbabe]

bluejoan - We brought up PICSI ourselves. Our RE thinks that it can't hurt, but told us that when they put the swimmers in the dish with the medium, it's basically anything that's alive that sticks to the medium? (She's a realist, so I appreciate her honesty.)

When we had our transfer, we were told that we had 5 excellent quality embryos, we'd transfer 1, then freeze the other 4, and watch a few more of them until day 6, since they were early blasts. When we found out that all of our embies arrested, I requested a copy of the embryology report, and looked up what the grading scale actually was, only to find out that our embryos were actually not as good as what the embryologist had told us. (We were told that a "Grade 1" was the best, when in reality, it's the worst.)

I don't remember much of our WTF (it was in August, and I was super emotional at the time), but when we went in for our consult for our next cycle, our RE told us that we were lied to, and that the embryos were in fact very poor quality. Her plan is to get as many eggs as humanly possible (and that we will likely have to do a freeze-all, because she is assuming that I will get OHSS), in the hopes that we get at least 1 good quality embryo.

So basically, we did get an embryo report, but the embryologist wasn't very good about interpreting it with us (though, it's a teaching hospital, so maybe they just really fucked it up and the embryologist was a student/intern/resident/whatever they call them, and they were mistaken - it doesn't matter because it doesn't change the fact that we transferred the best quality one we had) and the RE *did* go over our embryology report with us. We made the plan to do PICSI together, and I'm just making sure to be as healthy as I can so that at least the eggs that they get out of me will have the best chance to meet up with the best sperm?

[tkb24]

I asked about the DNA frag test also and the RE said they used to recommend them regularly but then stopped because unless it came back completely 100% horrible results, it didn't usually change the treatment plan. But I'm keeping this test on the back burner if the IUIs don't work.

[bluejoan]

tptbabe - Thank you for the information.  Our report basically said 7 fertilized, 5 made it to day 3 that were Fair/Poor Quality, 2 Transferred (1 fair, 1 fair/poor), remaining 3 arrested.  It was that one sentence on a huge sheet of paper with nothing else on there.  When I called to talk to someone in embryology they said that the RE would go over everything if they needed to.

I've also been trying to get healthier before we cycle again and have been slowly overhauling everything in our house to follow ISWTE guidelines.  

[tptbabe]

That's crazy that your whole embryology report was one sentence!!! We got a chart with the information on each egg, then embryo for each day that they checked them. (Every day except day 4, and they called each day with an update as well.) Everything looked perfect up until the day of transfer? We even got info on the immature eggs. We started out with 13 mature eggs, and one that was borderline (and 4 immature eggs), 13 fertilized, and all made it to day 3, looking perfect. It's so frustrating!!!

[tptbabe]

Also, we're on the ISWTE program too

[goldenlove3]

Wow, thanks for all the input ladies. I think I'll mention it to our RE just to see what the costs would be. I don't think I'd pay $500 OOP though but it doesn't hurt to ask. It's just so hard to be unexplained. The engineer in me doesn't want to except it and wants to know what the heck the real issue is.

[goldenlove3]

tptbabe I can't believe they gave you the completely wrong information. That is crazy!

[tptbabe]

Jan 21, 2015 10:47:55 GMT -5 goldenlove3 said:

Wow, thanks for all the input ladies. I think I'll mention it to our RE just to see what the costs would be. I don't think I'd pay $500 OOP though but it doesn't hurt to ask. It's just so hard to be unexplained. The engineer in me doesn't want to except it and wants to know what the heck the real issue is.

This is so me. (Except I'm not an engineer ) I think I'd go completely insane if we were unexplained! I don't know how anybody can stay mentally healthy through all this without knowing *something*? It's tough enough when you have an answer!

[tptbabe]

goldenlove3 - We're pretty pissed about it. Our RE was shocked and is trying to figure out what the heck happened there! Our clinic works as a team, and so she wasn't the one who did the transfer. It's also a teaching hospital, so you get alot of people cycling (ha! no pun intended!) in and out of there. The REs are constant, but you get residents tagging along, and doing the procedures sometimes too. One of the residents is AWESOME and totally saved my sanity when we were cycling before. She was there for our last consult as well. I'm glad she's still around

[goldenlove3]

Jan 21, 2015 10:51:28 GMT -5 tptbabe said:

Jan 21, 2015 10:47:55 GMT -5 goldenlove3 said:

Wow, thanks for all the input ladies. I think I'll mention it to our RE just to see what the costs would be. I don't think I'd pay $500 OOP though but it doesn't hurt to ask. It's just so hard to be unexplained. The engineer in me doesn't want to except it and wants to know what the heck the real issue is.

This is so me. (Except I'm not an engineer ) I think I'd go completely insane if we were unexplained! I don't know how anybody can stay mentally healthy through all this without knowing *something*? It's tough enough when you have an answer!

Yea it's funny how it's a perfectly ok answer to say "we have no idea what's wrong with you". I work in automotive and if there's an issue, I have to provide a detailed analysis of what went wrong, why and how we will prevent it from ever happening again. 

[bluejoan]

Jan 21, 2015 10:38:15 GMT -5 tptbabe said:

That's crazy that your whole embryology report was one sentence!!! We got a chart with the information on each egg, then embryo for each day that they checked them. (Every day except day 4, and they called each day with an update as well.) Everything looked perfect up until the day of transfer? We even got info on the immature eggs. We started out with 13 mature eggs, and one that was borderline (and 4 immature eggs), 13 fertilized, and all made it to day 3, looking perfect. It's so frustrating!!!

They did call to say that we had 10 retrieved, 7 mature and then called again to tell us 5 fertilized but the lack of info is driving me crazy.  I'm not sure if it's the clinic we choose or since we're travel clients.  I intend to ask a lot o questions.  

We also had 17 follies at our final monitoring but 4 off them were over ripe due to needing to use Cetrotide to bring my estrogen down to a reasonable level.  It was at 7600ish and we were able to get it down to 3200ish before trigger (numbers may be slightly off since I'm not logging into Voldeboard)

[cindal]

It sounds like the SCSA test to me which is what my husband just got done for the second time. It measures DNA fragmentation of the sperm. Our first SCSA indicated that his sperm was 70% fragmented. Under 15% is the normal range. We actual just got the results back after one month of high anti-oxidant and vitamin rich diet and it dropped to 10%. I'm assuming that since these sperm couldn't have been made during the time period of the diet changes that the fragmentation occurs while the sperm is waiting to be released. So therotically create a nicer environment for them and they recieve less damage and therefore less fragmentation. Our SCSA was $180.

[tikoberry99]

goldenlove3 I was thinking of posting an unexplained infertility post to see if there was any information our RE's have provided regarding unexplained infertility that might help us all. My RE did say that if IUI's didn't work that the issue was most likely that the sperm ran out of steam and couldn't penetrate the egg, or my eggs have a hard surface which makes it hard for the sperm to penetrate....which would ultimately mean IVF. I have read about damaged DNA in sperm being an issue, but how does one bring that up to their spouse? My fiance had his SA done and came back with FLYING colors and even the nurses were asking me what I was feeding him after they looked at his numbers prior to our IUIs. He thinks his sperm are super sperm and I suspect it is possible maybe their is some DNA damage. He smoked a ton of weed during his teenage years and into his 20's and did some other drugs and was a HUGE drinker...so it makes me wonder....

[murrt]

Umm...can anyone explain the difference between PICSI and ICSI to me? I go in for IVF consult on Monday and I know the RE is thinking we'll likely do ICSI b/c DH's morphology is 2%.

[goldenlove3]

Jan 21, 2015 14:42:13 GMT -5 tikoberry99 said:

goldenlove3 I was thinking of posting an unexplained infertility post to see if there was any information our RE's have provided regarding unexplained infertility that might help us all. My RE did say that if IUI's didn't work that the issue was most likely that the sperm ran out of steam and couldn't penetrate the egg, or my eggs have a hard surface which makes it hard for the sperm to penetrate....which would ultimately mean IVF. I have read about damaged DNA in sperm being an issue, but how does one bring that up to their spouse? My fiance had his SA done and came back with FLYING colors and even the nurses were asking me what I was feeding him after they looked at his numbers prior to our IUIs. He thinks his sperm are super sperm and I suspect it is possible maybe their is some DNA damage. He smoked a ton of weed during his teenage years and into his 20's and did some other drugs and was a HUGE drinker...so it makes me wonder....

I think that is a good idea! It would be nice to hear what others have found out about unexplained IF.

Last night I just mentioned to H that I found the article and what it was about. He has great numbers too except his morph is borderline at times. But after the wash, everything is always great. I hated bringing it up but it might be something that we should explore. 

[twinkie0612]

We went ahead and did the SCSA testing on my husband's sperm, only beacuse we wanted to make sure there were no issues going forward with IVF #4.  His testing came back in the excellent range.  I think I have read that test results can vary and that one good test doesn't mean that there are no DNA fragmentation issues.  However *most* men with DNA fragmentation issues also have MFI, so since his SA numbers were normal (except borderline morph) there is a good chance that DNA fragmentation is not the issue.  We are pretty sure that our embryo quality issues stem from egg issues since our embryos start off poor quality, we were just trying to judge the odds of also having a sperm issue.  There aren't many treatments for DNA fragmentation, some suggest antioxident supplements, but they aren't proven to help.  We were planning on using donor sperm if his tests came back showing high fragmentation.